Talk about your various addictions here

Can Alcoholism Be Treated?Research shows how stubborn addictions are -- and how medications may help

BusinessWeek Online
By Catherine Arnst in New York

Dr. Olivier Ameisen is a 51-year-old cardiologist in Paris. He is also an alcoholic. Between 1997 and 2004, Ameisen was hospitalized numerous times for drinking. He went through years of rehabilitation programs and attended two Alcoholics Anonymous meetings a day, some 700 a year, for seven years. All to no avail. His craving for drink always overwhelmed his desire to quit.

By January, 2004, Ameisen came to believe his only hope would be a drug that could dampen those cravings. But despite the fact that alcoholism is widely recognized as a medical condition, there were only two medications available, and neither had worked for him. Ameisen researched the literature and came across rat studies showing that baclofen, a generic drug used to control muscle spasms, could suppress the desire to consume alcohol by interfering with the reward circuitry in the brain. It is also used to treat anxiety disorders, which afflict large numbers of alcoholics, including Ameisen.

The doctor decided to self-prescribe the drug at high doses. And he took the unusual step of writing himself up as a case study this past December in the journal Alcohol & Alcoholism. After nine months on baclofen, he reported that he had not had a drink since Jan. 9, 2004, and, more important, that he had experienced "no craving or desire for alcohol for the first time in my alcoholic life. Even in a restaurant with friends, I was indifferent to people drinking. This had never occurred before."

Ameisen's detailed report adds to a growing body of evidence that alcoholism -- and addiction itself -- has unique pathologic traits that can be corrected through chemical intervention. Drug researchers are now striving to bring science to bear on what was long treated as a social problem rather than a medical one. Over the last decade, sophisticated brain-imaging technologies have demonstrated that constant use of alcohol significantly alters the structure of the brain in ways that can last for months and even years, creating a chronic brain disease. With this knowledge in hand, the search is on for drugs that can restore the brain to its pre-drinking state.

Forest Laboratories Inc. (FRX ) started marketing one promising medicine in the U.S. in January. Campral, the first alcoholism drug to win Food & Drug Administration approval in 10 years, is designed to suppress alcohol cravings by targeting specific brain chemicals thrown out of balance by drinking. Alkermes Inc. (ALKS ) filed for FDA approval of its own anti-craving drug, Vivitrex, on Apr. 1.

CONVERGING FORCES
Neither drug is new. Campral has been on the market in Europe for 15 years, and Vivitrex is a once-a-month, injectable form of naltrexone, a daily pill approved for alcoholism in 1994. Nor are Campral and Vivitrex miracle cures. Dr. Ameisen tried both, to no effect. Clinical trials have shown that they can help patients remain abstinent two to three times longer than those on placebo, but the relapse rate is high.

Still, these medicines prove the principle: Drugs that target the brain's addiction pathways can curb drinking. Scientists have also discovered that almost any addiction, be it alcohol, cocaine, nicotine, even gambling, involves many of the same pathways. A drug that treats one addiction may be effective against others. As a result, research in this field is rapidly accelerating. "I've been treating addiction for over 20 years, and for the first time I believe there is a convergence of various forces that will get medications out there," says Dr. Richard N. Rosenthal, chairman of the Psychiatry Dept. at St. Luke's-Roosevelt Hospital Center in New York. "The pharmaceutical industry is finally getting interested."

Drug companies have good reason to be pay attention -- alcoholism is one of medicine's largest unmet needs. The National Institute on Alcohol Abuse and Alcoholism estimates that almost 18 million people in the U.S. abuse or are addicted to alcohol. They cost the nation some $185 billion a year in medical services, lost wages, and law enforcement resources. Yet each year only two million alcohol-dependent people seek treatment, and up to 90% relapse within four years.

Despite the huge number of sufferers, alcoholism was "underscienced" for years, says Alkermes CEO Richard F. Pops. Since 1935, when Alcoholics Anonymous was founded, the vast majority of treatment efforts in the U.S. were based on AA's 12-step program, requiring behavioral changes and faith in a higher power. "The history of treatment in this country was not consistent with the idea that medicines could help," says Dr. Klye M. Kampman, associate professor of psychiatry at the University of Pennsylvania. "We were very moralistic."

For decades the only alcoholism drug in the U.S. was Antabuse, which causes people to vomit when they drink. Even now, only some 140,000 alcoholics in the U.S. receive medication for their disease, ranging from Antabuse to anti-depressants to anti-seizure drugs. There was no move to introduce Campral in the U.S. until Forest licensed it from Germany's Merck in 2001.

A clearer understanding of the biological underpinnings of alcoholism is opening the way to better drugs. Scientists have identified a number of genes that confer a predisposition to alcohol addiction. They have also found that the brain goes through profound changes when a person starts drinking to excess.

Alcohol releases a neurotransmitter called GABA (gamma-aminobutyric acid), instrumental in creating a sense of euphoria. Too much GABA can impair muscle control and slow reaction times, so the brain releases a stimulating chemical called glutamate to keep it in check. When alcohol is cut off, glutamate levels remain high and can cause irritability and discomfort. To relieve those feelings, the brain craves another drink. As more GABA and glutamate are released, brain cells change their structure to accommodate the excess chemicals, making them dependent on these levels. When alcohol is withdrawn, painful emotional and physical reactions are set off.

GABA may be the reason people drink, but glutamate is the reason they can't stop. This powerful neurotransmitter is a key player in the brain's learning centers, and excess amounts create deeply embedded memories of drinking. Years after a person quits, these memories can be triggered by a place, person, or even smell associated with drinking, setting off intense cravings. Such cue-induced cravings are the main reason for relapse. "They're why it can be easy to get off a drug, but it's very hard to stay off," says Dr. Herbert D. Kleber, director of the division on substance abuse at Columbia University.

Campral helps alcoholics resist these cravings by checking production of glutamate, bringing the brain's chemistry back into balance. Clinical studies of Campral have shown that after six months of treatment, 36% of patients were still abstinent, compared with 23.4% on placebo. Vivitrex dampens cravings by a slightly different mechanism, calming opioid receptors in the neurons that are overstimulated by alcohol. A recent study showed that Vivitrex can help people cut way down on alcohol bingeing. That's not the same as abstinence, but Dr. James C. Garbutt, an alcoholism researcher at the University of North Carolina at Chapel Hill, says reduced drinking is still meaningful in a disease that is remarkably resistant to treatment. "If you significantly reduce the number of heavy drinking days, you've made a big impact." Treatment specialists believe that Campral and Vivitrex may be most effective when used in combination.

INDIFFERENCE AT LAST
Existing drugs approved for other purposes may end up being part of that combination. The field got a jolt last August from a study in The Lancet that showed that Topamax, an anti-seizure medicine from Johnson & Johnson (JNJ ), helped 13 of 55 patients abstain from drinking for a month. Dr. Bankole A. Johnson of the University of Texas Health Science Center at San Antonio, who headed the study, said the patients all started on the drug while still drinking, a significant breakthrough. Campral is taken after the patient quits.

Still, no drug is recommended in a vacuum. "We are developing better and better medications, but they need to be taken in a therapeutic context," says Kleber -- which may include AA and other types of behavioral therapies. Dr. Ameisen, for one, found it much easier to use the techniques he learned at AA while on baclofen. But it was the drug that changed his life. "At the end of my ninth month of complete liberation from symptoms of alcohol dependence, I remain indifferent to alcohol," he writes. "Abstinence has become natural to me."

I didn't read your long post, but my guess would be that alcoholism can be treated, but whether it is successful or not is another matter. Several of my friends have alcoholic sons, and they will remain an alcoholic for the rest of their lives - probably short ones. It's very tough on the parents too, because they are helpless. Alcoholism is a disease, but the cure rate I would opine is less than five percent.

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ossobuco

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Thu 4 Aug, 2005 10:41 pm

Edited - I first read the piece as a marketing ploy, was mistaken.

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Walter Hinteler

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Fri 5 Aug, 2005 12:56 am

Well, as an alcoholic myself and as someone, who worked professionally in this field (as well as with and in self-help-groups), I surely think, alcoholism can be treated.

Hower, any pharmaceutical help is useless, if the patient hasn't change her/her life.

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Walter Hinteler

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Fri 5 Aug, 2005 12:58 am

And of course, you'll be an alcoholic your life long - living in abstinence, though, after a treatment - hopefully.

(Either you die over short or a bit longer, or you stop drinking - and it really matters only little how you reach this better status :wink: )

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Reyn

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Fri 5 Aug, 2005 07:22 am

ossobuco wrote:

In any case, if anyone wants to convince the body of viewers at a2k, over time, they need to come up with serious data, double blinded,

I wasn't trying to convince anybody of anything. Nor am I selling anything.

I found this merely as "interesting". Was thinking maybe others would also.

Don't shoot the messenger, eh?

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Bella Dea

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Fri 5 Aug, 2005 07:28 am

I definitly think it can be. Once the physical dependancy is over, treating the mind is key. Just like smoking.

I've heard that nicotine is the most powerful of addictions. Is that not true?

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Walter Hinteler

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Fri 5 Aug, 2005 08:23 am

Well, this opinion might be true - especially in a society, which tolerates drinking but demonises smoking.

To be honest, by my own experience (as well as that of some hundred similar I know) and by what I've read in literature, I have a different knowledge - which isn't up tp date re litterature.

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eoe

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Fri 5 Aug, 2005 08:38 am

Please expound. I'm very curious coming from a family rife with alcohol and ciggie addictions. Like most families.

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Walter Hinteler

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Fri 5 Aug, 2005 08:43 am

Well, one point certainly is that society makes it much easier not to smoke again and to have the next drink.

The more important, hoever, is the psysical 'relief' you have as an addict: the world looks much nicer and the problems are gone after some drinks; but not after a packet of cigarettes.

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eoe

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Fri 5 Aug, 2005 10:15 am

Oh, a cocktail and your favorite tv show always goes better with a cigarette. In a crisis? Have a smoke to calm your nerves. Just sitting and chilling goes better with a smoke. Or reading. Or writing. Or painting. Coffee. After making love. Driving...

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Walter Hinteler

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Fri 5 Aug, 2005 10:29 am

Okay, if you see this way.

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Walter Hinteler

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Fri 5 Aug, 2005 10:36 am

On the other hand: do you know of many who stole for cigarettes, killed others or themselves due to cigarettes, lost their family, job, friends etc due to cigarettes .... and still thought, they and there life were okay?

I think, it's always a lot of self-experience in when you describe something as "the most powerful of addictions".

Actually, any drug you are on, is the most powerful - for the addicted and his environment.

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ossobuco

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Fri 5 Aug, 2005 10:36 am

Reyn wrote:

ossobuco wrote:

In any case, if anyone wants to convince the body of viewers at a2k, over time, they need to come up with serious data, double blinded,

I wasn't trying to convince anybody of anything. Nor am I selling anything.

I found this merely as "interesting". Was thinking maybe others would also.

Don't shoot the messenger, eh?

Sorry, Reyn, I see I misdirected my doubts.

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Bella Dea

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Fri 5 Aug, 2005 11:41 am

Walter Hinteler wrote:

Bella Dea wrote:

Just like smoking.

Only a bit different :wink:

Are you kidding? To quit smoking is like having to cut off your left arm. Seriously. It is so hard.

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Walter Hinteler

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Fri 5 Aug, 2005 11:53 am

No, I'm not kidding.

Walter Hinteler wrote:

Actually, any drug you are on, is the most powerful - for the addicted and his environment.

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Bella Dea

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Fri 5 Aug, 2005 11:57 am

I've never been an alcoholic so I guess that I can't say with 100% certainty which is harder but I can tell you that quitting smoking is the hardest thing I've ever done.

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cicerone imposter

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Fri 5 Aug, 2005 01:43 pm

My experience is the same as Bella Dea's; I've never had any trouble with alcoholism, so I can drink or not drink on any day. However, it took me three cold-turkey tries to quit smoking - and that was over 40 years ago. I don't mss smoking any more, and cigarette smoke bothers me a little when other people smoke, but I can't handle my hotel pillow or room smelling like cigarette smoke. UGH!